GPs drop out of high-profile hospital integration scheme

The number of GP practices subcontracted to a West Midlands hospital trust as part of a 'vertical integration' scheme has dropped, the trust has confirmed.

NHS integration plans (Photo: SOPA Images/Getty Images)
NHS integration plans (Photo: SOPA Images/Getty Images)

GPonline reported last year that the Royal Wolverhampton NHS Trust (RWT) had taken control of 10 GP practices through its ‘vertical integration’ programme, covering roughly 100,000 patients.

Trust leaders told GPonline that the scheme - which asks practices to give up their independent contractor status in order to become subcontracted to the hospital - had proved so successful that plans to replicate the model across ‘17 health economies in other parts of England’ were being examined.

However, the RWT has now confirmed that the number of practices involved in the vertical integration scheme has fallen to eight. Wolverhampton LMC has previously warned that the scheme could lead to the ‘implosion’ of general practice in the area.

Vertical integration

But Sultan Mahmud, director of integration at RWT, said: ‘We are currently responsible for the delivery of care in eight GP practices. Another practice will be joining us in the summer and also have several more currently going through the due diligence process.

‘The vertical integration programme has helped us work a lot closer with local respected GPs to deliver better patient experience and increase value for the taxpayer and bring together clinicians across the primary, secondary and community care sectors.’

Since its inception in 2016, the hospital trust says its vertical integration programme has freed up 50,000 GP appointments - 400 per month per practice - and reduced emergency hospital admissions by 11%.

Dr Mona Sidhu - herself a GP whose practice has been taken over by the RWT - said integration was a positive move which equips GPs with the necessary resources to provide better patient care.

Speaking at a King’s Fund event last year, Dr Sidhu said: ‘It wasn’t about more money in my pocket or more money from the trust - it was purely to drive better patient care. And we wanted to remove the primary and secondary care divide… and make sure our incentives were aligned…. This is an option we came to after exploring various other options, this was the most sensible to get us to where we wanted.’

Practice management

GP partners who join the scheme must also become salaried employees of the trust. Dr Sidhu said this brings benefits including reduced workload, access to HR, paid-for indemnity, unified policies and ‘robust governance processes’.

But Wolverhampton LMC medical secretary Dr Gurmit Mahay previously told GPonline that he found it ‘disappointing’ to see GPs giving up their independent contractor status in the face of 'immense pressure'.

He said the loss of independence 'is not good for the profession, and not good for the GPs in the longer run', adding that 'inevitably there will be a point of critical mass when independent general practice in Wolverhampton will implode’.

Mr Mahmud added: ‘The focus of the trust is to continue working with all GP groups, Wolverhampton CCG, Wolverhampton City Council, The Black Country Partnership NHS Trust, patient groups and the third and voluntary sector to provide support and guidance so that we can achieve the best experience for our patients and work as one system.

‘We know that NHS trusts of the future have increasingly a duty to think beyond the walls of the hospital and ensure gaps in care are minimised. Therefore we must have a range of options for primary care to work with NHS trusts and I am really pleased to say RWT is developing collaboration models that cater for the wide range of preferences that primary practices have in respect of integration.’

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